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Age Cutoff for the Loss of Survival Benefit From Use of Radial Artery in Coronary Artery Bypass Grafting
Study Questions:
What is the survival benefit from use of the radial artery (RA) in relation to a patient’s age?
Methods:
Propensity score matching was conducted on 9,005 patients who underwent first-time isolated coronary artery bypass grafting (CABG) using the left internal thoracic artery (LITA) at a single institution, from 1996 to 2012. The use of RA was recorded in 936 patients, whereas the use of saphenous vein grafts (SVGs) only was recorded in 8,069 patients. The primary study endpoint was all-cause death. The interaction between patient’s age and any survival benefit from the RA was assessed by spline analysis.
Results:
After propensity matching, the sample size consisted of 809 matched pairs. In the matched group, mean follow-up was 6.4 ± 3.6 years (range, 0-13.6 years). Survival was 96.8% ± 0.6% versus 96.0% ± 0.6% at 1 year, 91.4% ± 1.1% versus 90.1% ± 1.0% at 5 years, and 83.2% ± 1.7% versus 79.4% ± 1.9% at 10 years for patients receiving RA or SVG, respectively. RA use was associated with a lower risk for late death (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.57-0.98; p = 0.03). However, the protective effect from RA on late survival was not equally present across all age groups, as shown by spline analysis. The survival advantage from RA was maximum in patients 60 years and younger (upper limit of 95% CI, <1) and gradually declined with increasing age, until it was no longer present in patients older than 70 years (adjusted HR, 0.90; 95% CI, 0.63-1.28; p = 0.57).
Conclusions:
The authors concluded that the use of the RA graft as a second conduit improves all-cause mortality in patients undergoing primary isolated CABG up to the age of 70 years.
Perspective:
This study reported that in patients with multivessel coronary disease undergoing first-time CABG, the use of RA as a second conduit (in addition to LITA-left anterior descending artery [LAD]) is associated with improved long-term survival, when compared with patients receiving only LITA-LAD and only SVGs. However, this benefit was not constant across all age groups: the survival benefit conferred by the use of RA gradually becomes less evident with increasing age, and is no longer present for patients older than 70 years. On the basis of these data, although the choice of surgical strategy should be individualized for each patient, the use of RA grafts for first-time isolated CABG may be considered as the best option in patients, at least until the age of 70 years.
Keywords: Cause of Death, Propensity Score, Radial Artery, Saphenous Vein, Socioeconomic Factors, Coronary Disease, Confidence Intervals, Coronary Vessels, Coronary Artery Bypass
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